Provider Data Integrity Specialist

Versant Health, Inc.; City of Troy (NY); On-site; USD 26,000 - 36,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Tuition reimbursement

401(k) with company match

Pet insurance

No-cost vision insurance

Job summary

Versant Health, Inc. is seeking a Provider Data Specialist in Troy, NY to educate, verify, and manage all provider, office, and payee data across multiple provider databases.

You will perform additions, changes, and terminations to improve the accuracy of the Provider Directory and claims processing, with audits and data controls across payees and Medicaid registrations. The role requires 4–5 years in a managed care setting, knowledge of CMS rules, and strong MS Office skills.

Qualifications

• Ability to handle PHI/PII with discretion and trust.
• Experience with provider data management and credentialing.
• Knowledge of CMS Provider Directory regulations.

Responsibilities

• Create and maintain provider, office, and payee records in provider databases.
• Review and edit provider data to facilitate accurate claims and authorizations.
• Process terminations using correct codes after review of documentation.
• Manage provider data rosters and perform updates in provider databases.
• Support accounts receivable with provider education on negative balance accounts and network suspensions/reactivations.
• Educate providers on data quality and its impact on directories and claims.

Skills

PHI/PII handling

CMS regulations

provider data management

Education

Associate or Bachelor’s degree preferred

Tools

Microsoft Excel

Microsoft Word

Microsoft Access

PowerPoint

Job description

Versant Health, Inc. is seeking a Provider Data Specialist in Troy, NY to educate, verify, and manage all provider, office, and payee data across multiple provider databases.

You will perform additions, changes, and terminations to improve the accuracy of the Provider Directory and claims processing, with audits and data controls across payees and Medicaid registrations. The role requires 4–5 years in a managed care setting, knowledge of CMS rules, and strong MS Office skills.